Endoscopic skull base reconstruction of large dural defects: A Systematic Review of Published Evidence

Authors


  • Richard J. Harvey, MD, has served on the advisory board for Schering Plough and serves on the speaker's bureau for GlaxoSmithKlein, MSD, and Arthrocare. He is also a consultant for Medtronic and Olympus and grant recipient from NeilMed Pharmaceuticals. Raymond Sacks, MD, is a consultant to Medtronic and Nycomed. The authors have no other funding, financial relationships, or conflicts of interest to disclose.

Abstract

Objectives/Hypothesis:

Systematically review the outcomes of endoscopic endonasal techniques to reconstruct large skull base defects (ESBR). Such surgical innovation is likely to be reported in case series, retrospective cohorts, or case-control studies rather than higher level evidence.

Study Design:

Systematic review and meta-analysis.

Methods:

Embase (1980–December 7, 2010) and MEDLINE (1950–November 14, 2010) were searched using a search strategy designed to include any publication on endoscopic endonasal reconstruction of the skull base. A title search selected those articles relevant to the clinical or basic science of an endoscopic approach. A subsequent abstract search selected articles of any defect other than simple cerebrospinal fluid (CSF) fistula, sella only, meningoceles, or simple case reports. The articles selected were subject to full-text review to extract data on perioperative outcomes for ESBR. Surgical technique was used for subgroup analysis.

Results:

There were 4,770 articles selected initially, and full-text analysis produced 38 studies with extractable data regarding ESBR. Of these articles, 12 described a vascularized reconstruction, 17 described free graft, and nine were mixed reconstructions. Three had mixed data in clearly defined patient groups that could be used for meta-analysis. The overall CSF leak rate was 11.5% (70/609). This was represented as a 15.6% leak rate (51/326) for free grafts and a 6.7% leak rate (19/283) for the vascularized reconstructions (χ2 = 11.88, P = .001).

Conclusions:

Current evidence suggests that ESBR with vascularized tissue is associated with a lower rate of CSF leaks compared to free tissue graft and is similar to reported closure rates in open surgical repair.

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